Self-assessed health status provides an overall measure of a population's health based on individuals' personal perceptions of their own health. Health is recognised as having physical, mental, social, and spiritual components and measures of health must therefore go beyond more objective measures such as morbidity and mortality. Self-assessed health provides a suitable broad measure of health status. It is dependent on an individual's awareness of their health as well as the social constructs and definitions of health that surround them. There may therefore be inconsistencies between a person's own self-assessed health status and their health status as measured by objective health assessment techniques (AHMAC 2006). Despite self-assessed health status being a subjective measure of health status, international studies have found it has strong predictive power for subsequent mortality (Quesnel-Vallee 2007).

In the 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), around 43% of the Indigenous population aged 15 years and over reported their health as very good or excellent, 35% reported their health as being good and 22% reported their health as fair or poor. After adjusting for differences in the age structures of the Indigenous and non-Indigenous populations, Indigenous Australians were twice as likely as non-Indigenous Australians to report their health as fair or poor in 2004-05 (ABS 2006c).

The proportion of both Indigenous and non-Indigenous Australians reporting fair or poor health was higher in older age groups (graph 7.1). Around one in ten Indigenous Australians aged 15-24 years ( 9%) reported fair or poor health compared with 50% of those aged 55 years and over (ABS 2006c).

Indigenous females were more likely to report their health as fair or poor than Indigenous males (24% compared with 19% respectively). Indigenous Australians aged 15 years and over in non-remote areas were more likely than those in remote areas to report fair or poor health (23% compared with 19%) (AIHW 2007a).

Between 1994 and 2004-05, the proportion of Indigenous Australians who reported their health as fair or poor increased from 18% to 22%. There were corresponding decreases in the proportions reporting their health status as good and excellent/very good (table 7.2). The increase in the proportion reporting fair/poor health was more pronounced among Indigenous females, rising from 17% in 1994 to 24% in 2004-05.

Health status is related to socioeconomic status - people with higher socioeconomic status generally enjoy better health than those with lower socioeconomic status. In 2004-05, Indigenous adults with relatively high equivalised household incomes (as measured by the fourth and fifth quintiles) were more likely to report very good or excellent health than those with lower equivalised household incomes (49% compared with 33%) (table 7.3). For more information on equivalised income and income quintiles, see Glossary.

Indigenous males and females who had completed Year 12 or equivalent were also much more likely to report very good or excellent health (54% of males and 50% of females) compared with those whose highest level of schooling was Year 9 or below (28% of males and 29% of females). Similarly, employed Aboriginal and Torres Strait Islander people were more likely than those who were unemployed to report very good or excellent health (48% compared with 41%) (table 7.3). Those who were not in the labour force were even less likely than the unemployed to report very good or excellent health (29%), however, this is probably also age-related (i.e. older people comprise a greater share of those who are not in the labour force, and a smaller share of those with very good or excellent health).

After adjusting for age differences between the Indigenous and non-Indigenous populations, Indigenous adults were less likely than non-Indigenous adults with the same socioeconomic characteristics to report very good or excellent health. Apart from unemployed Indigenous and non-Indigenous females who were equally likely to report very good or excellent health, Indigenous to non-Indigenous sex-specific rate ratios were between 0.6 and 0.8 for the selected socioeconomic characteristics (table 7.3).

7.3 SELECTED SOCIOECONOMIC CHARACTERISTICS, Proportion of Indigenous persons aged 18 years and over with excellent/very good health - 2004-05

Proportion with excellent/very good health

Indigenous to Non-Indigenous rate ratio(a)

Males

Females

Persons

Males

Females

Persons

%

%

%

rate

rate

rate

Equivalised gross household income(b)

Lowest quintile

31.3

34.2

33.0

0.8

0.7

0.7

Second quintile

42.0

37.1

39.3

0.7

0.6

0.7

Third quintile

51.9

43.6

48.1

0.8

0.7

0.7

Fourth and fifth quintile

46.8

51.6

49.2

0.7

0.7

0.7

Highest year of school completed(c)

Year 9 or below(d)

28.3

28.5

28.4

0.8

0.7

0.7

Year 10 or 11

45.5

39.8

42.4

0.6

0.6

0.7

Year 12 or equivalent

54.0

50.2

51.9

0.7

0.6

0.7

Labour force person

Employed

48.7

46.0

47.5

0.7

0.6

0.7

Unemployed

43.2

37.8

40.8

0.6

1.0

0.8

Not in the labour force

23.5

32.1

29.3

0.7

0.6

0.6

(a) Rate ratios are the age standardised rates for Indigenous persons divided by the rates for other persons. Rates are directly age standardised to the 2001 Australian population.

(b) The annual household income quintile boundaries are based on the equivalised gross household income per week for the total population of Australia. Boundaries are as follows: lowest quintile $0-264 per week; second quintile $265-426 per week; third quintile $427-611 per week; fourth quintile $612-869 per week; and fifth quintile $870 or more per week.

(c) Excludes persons still at school.

(d) Includes persons who never attended school.

Source: AIHW analysis of the ABS 2004-05 NATSIHS

Self-assessed health status and other selected indicators

According to the 2004-05 NATSIHS, Indigenous adults who reported having been removed from their natural families as children were more likely to report fair or poor health (35% of men and 41% of women) than those who had not (20% of men and 25% of women). Indigenous adults who spoke English as their main language at home were more likely to report fair or poor health (22% of men and 27% of women) than those who spoke an Aboriginal or Torres Strait Islander language at home (19% of both men and women).

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